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Health Insurance

AMA, AHA Call for Stronger Patient Insurance Protections

June 15, 2017 - The American Medical Association (AMA) has joined seven prominent health industry groups in calling for the Senate to address patient protection concerns regarding health insurance coverage.  The move by eight of the nation’s leading healthcare organizations, including the American Hospital Association (AHA), Federation of American Hospitals (FAH), and AARP, comes in the face of...


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Cigna, CVS MinuteClinics Partner for Expanded Healthcare Access

by Jesse Migneault

Cigna and CVS Health have partnered to launch Cigna Health Works for expanded healthcare access for the payers employer-based health plan members.  The launch is currently limited to certain markets only. Cigna Health Works will align members...

Employer Health Plans See Spike In Out-of-Pocket Costs

by Jesse Migneault

The National Center for Health Statistics study found a double-digit increase in the use of high-deductible employer health plans has generated increased economic strain for members. Beneficiaries reported struggling to pay medical bills or delaying...

ACA Medicaid Expansion Boosted Care Access, Patient Outcomes

by Jesse Migneault

Low-income adults taking advantage of the Affordable Care Act’s Medicaid expansion experience more financial stability and better outcomes, according to a new study from the Harvard T. H. Chan School of Public Health. “Our four years...

$18M Claimant Case Challenges Affordable Care Act Payers

by Jesse Migneault

In April of 2017, Wellmark Blue Cross Blue Shield, which operates in Iowa and South Dakota, announced it would exit the 2018 health insurance exchanges.  The payer cited higher than expected claims costs, including Member X, who had claims...

Healthcare Costs Vary Widely Across Geographic Regions

by Jesse Migneault

New research from the Health Care Cost Institute (HCCI) shows that healthcare costs for three common procedures, including knee injections, ACL repairs, and knee replacements, varied greatly across 61 metro areas.   The results...

AHIP: Congress Must Stabilize Payer Market, Consider Reforms

by Jesse Migneault

With passage of the AHCA, the insurance industry group AHIP has sent its response to congress and presented its recommendations for what direction to go in with healthcare reform The payer industry organization submitted recommendations in four...

Harvard Pilgrim Enters Outcomes-Based Pharmaceutical Contracts

by Jesse Migneault

Harvard Pilgrim Health Care has signed a three-year value-based care contract with drug maker AstraZeneca for two therapies used to treat acute coronary disease and type 2 diabetes. The arrangements will use patient outcomes as a measure of the...

NC Payer Raises Health Insurance Rates Due to CSR Lawsuit

by Jesse Migneault

Blue Cross Blue Shield of North Carolina announced its 2018 individual premium rates will increase an average of 22.9 percent for coverage on and off the health insurance exchange in all 100 counties it serves.  The increase is a pinch lower...

Care Coordination is Tops for Health Insurance Satisfaction

by Jesse Migneault

Coordination of care among healthcare providers is the single most important criteria influencing member satisfaction with their health insurance plan, according to the J.D. Power 2017 Member Health Plan study.   Members expressed clear...

BCBS of Kansas City Will Leave ACA Health Insurance Exchange

by Jesse Migneault

The exit of Blue KC from the ACA health insurance exchange in 2018 will affect a 32-county service area in Kansas and Missouri, and leave both urban and rural counties without any marketplace exchange insurers. The payer blamed losses exceeding...

Single-Payer Healthcare Plan May Cost California $400 Billion

by Jesse Migneault

California’s proposed single-payer healthcare system would come with a $400 billion price tag, says a report from the state Senate on bill SB 562. The goal of the universal healthcare bill is two-fold: to tackle the issue of runaway premiums...

Anthem Terminates Cigna Merger, but Refuses to Pay Out $1.8B

by Jesse Migneault

After a court ruling in Delaware, Anthem has notified Cigna that their proposed $54 billion merger is off, but that doesn’t mean the two insurance companies are amicably parting ways. Anthem has stated that it will not pay Cigna a $1.85...

Patient Incentives from Payers Encourage Preventive Care Visits

by Jesse Migneault

To reduce payer claim costs, would you pay members to go see their doctor once a year?  That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies. For healthcare insurance payers,...

Anthem Pursues Cigna Merger Up to the Supreme Court

by Jesse Migneault

Just seven days after a court upheld the initial ruling which blocked Anthem’s acquisition of Cigna, the nation’s second largest insurer is not giving up.   Anthem has confirmed that it is filing a writ of certiorari with...

Pharmacy Benefit Managers Help Reduce Payer Drug Spending

by Jesse Migneault

Pharmacy benefit managers (PBMs) are instrumental in helping payers provide appropriate access to prescriptions, expand access, and rein in drug spending, according to a recent report from the Pharmaceutical Care Management Association (PCMA)....

Aetna Posts Q1 Loss After ACA Withdrawal, Merger Collapse

by Jesse Migneault

After a tumultuous 2016, Aetna announced a first-quarter 2017 net loss of $381 million, a significant  reversal from a $737 million profit a year ago. Aetna blamed the loss on costs associated with its attempted merger with Humana,...

Payers Offer 10 Ways to Improve Cost, Quality of Long-Term Care

by Jesse Migneault

The National Association of Insurance Commissioners (NAIC) issued ten long term care (LTC) federal policy recommendations to Congress.   The report was completed as part of the group’s Retirement Security Initiative.  NAIC...

Medicaid Service Equals or Surpasses Private Health Payers

by Jesse Migneault

A new report by the Commonwealth Fund found that Medicaid provides equal or better quality health coverage to private health insurance plans.  The Commonwealth Fund’s 2016 Biennial Health Insurance Survey measured statistics related...

PA Seeks Increased Payer Coverage of Emergency Air Ambulances

by Jesse Migneault

Emergency air ambulances save lives, but they can also leave patients in a mountain of debt.  Pennsylvania Insurance Commissioner Teresa Miller would like payers to shoulder more of the costs of these critical services, and has accordingly...

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